Maternal psychosocial risk factors and lower respiratory tract infection (LRTI) during infancy in a South African birth cohort

Abstract

ObjectiveTo investigate the association between maternal antenatal and/or postnatal psychosocial risk factors (including depression, psychological distress, alcohol abuse and intimate partner violence (IPV) and infant lower respiratory tract infection (LRTI) in a low- and middle-income-country (LMIC).Study designPregnant women (n = 1137) enrolled in a South African birth cohort study, the Drakenstein Child Health Study (DCHS) were longitudinally assessed for psychosocial risk factors including depression, psychological distress, alcohol abuse and/or intimate partner violence (IPV). Infants were followed from birth until one year of age for the development of LRTI by active surveillance. Two outcomes were evaluated: any LRTI, and severe and/or hospitalised LRTI. Logistic regression was used to identify associations between individual maternal psychosocial risk factors and LRTI outcomes. Analyses stratified by age were also performed to determine which age groups related to infant LRTI were linked with maternal psychosocial risk factors.ResultsThere were 606 LRTI episodes in 369 infants in the first year (crude incidence rate = 0.53 episodes per person-year, 95%CI: 0.50; 0.56); 31% (n = 186) of episodes were severe or hospitalised events. Maternal psychosocial risk factors were associated with LRTI and severe LRTI, particularly postnatal and long-term maternal psychological distress, antenatal maternal alcohol consumption, and postnatal maternal IPV. Age stratified analyses found that antenatal maternal alcohol consumption was associated with early infant LRTI, while antenatal maternal depression was linked with infant severe LRTI between 3 and 6 months of age, and postnatal maternal IPV was associated with early LRTI and severe forms of LRTI.ConclusionThe associations between maternal psychosocial risk factors and infant LRTI highlight the potential value of screening for maternal psychosocial risk factors in clinical settings and developing targeted interventions. Such interventions may not only improve maternal well-being, but also help reduce the burden of infant LRTI in LMIC settings.

Costs of common perinatal mental health problems in South Africa

“…Among those with depression meeting threshold for diagnosis or anxiety disorder 10% Dutch study (Spijker et al, 2002); similar values suggested by South African study (Garman et al, 2019b) Specifically, numbers of children with internalising or externalising problems or stunting linked to perinatal mental health problems were estimated from the number of women with perinatal depression. Numbers of children with lower respiratory tract infection in the first year or ongoing asthma (which is linked to perinatal psychological distress) were estimated from the number of children exposed to perinatal psychological distress (which overlaps with depression and anxiety) based on work by MacGinty and colleagues (MacGinty et al, 2018(MacGinty et al, , 2019. Evidence from that study indicated that lower respiratory infections occur only in the first year, whilst asthma develops as a long-term condition and persists over the lifetime (i.e.…”

“…Costs to the public sector refer to costs of hospitalisations of infants with episodes of severe lower respiratory tract infections linked to persistent psychological distress during the first year postpartum, calculated from South African evidence on hospitalisation risk (MacGinty et al, 2018(MacGinty et al, , 2019 and data on the average cost of a hospital stay (Ramjee, 2013).…”

“…In addition to causing substantial human suffering for women, there are well-established adverse impacts of untreated perinatal mental health problems on pregnancy outcomes, infant growth and development, and offspring educational attainments (Stewart, 2007 ; Stein et al ., 2014 ; Glover et al ., 2018 ). Evidence from South African studies shows negative impacts of postnatal depression or psychological distress on short- and long-term child outcomes, including respiratory tract infections, recurrent wheezing or asthma (MacGinty et al ., 2018 , 2019 , 2020 ; Kariuki et al ., 2020 ), stunting (Avan et al ., 2010 ; Tomlinson et al ., 2006 ), and mental health problems (Verkuijl et al ., 2014 ). Risk factors include a complex combination of genetic, biological, social, psychological and environmental factors.…”

Maternal Characteristics as Predictors of the Incidence of Acute Upper Respiratory Infection in Children Under Five Years Old in Indonesia

“…Maternal mental vulnerability, low family support, and low ability to financial problems will affect the child-rearing process [32,33]. Risk factors for maternal psychosocial conditions are associated with the incidence of severe lower respiratory tract infection and LRTI, especially for post-natal stress and long-term maternal psychological distress [34].…”

Impact of postnatal depression on neonatal outcomes: an exploratory study in Kisumu County, western Kenya

“…Postnatal depression (PND) is the most common complication of childbearing (1) and can seriously reduce a mother's ability to care for herself and her infant (2). It is a significant contributor to maternal morbidity and mortality in low-and middle-income countries (LMICs) and is associated with adverse health and growth outcomes in infants (3)(4)(5)(6)(7)(8). The prevalence of PND is twice as high in LMICs (20%) compared to high income countries (10%, HICs) (2).…”